Science of Collaboration

The discovery of the double-helical structure of DNA, the invention of the airplane, and the creation of the now world-famous Ben & Jerry’s ice cream company all share something in common: none would have been possible without collaborative efforts by those responsible for their success.1 In 1978, Ben Cohen’s creativity and Jerry Greenfield’s practicality merged to launch what would become a wildly successful ice-cream business.2 The duo’s shared values, unique capabilities, and open communication and commitment to their mission helped rocket Ben & Jerry’s to success. Today, they continue their collaborative efforts by forming partnerships with other individuals and companies that align with their values of social and environmental responsibility. Such collaborations extend far beyond the likes of Ben & Jerry, however, with outcomes of successful partnerships evident in fields ranging from business to music and beyond. Conceptualizing what collaboration is—and how to overcome barriers to it—will help foster success in other areas. Efforts to work together have existed long before the complex partnerships that are common today. Long-distance trade efforts dating back 150,000 years represent a primitive form of collaboration.3 Since then, the concept of working together has evolved in complexity and extended into many different fields, including sports, health care, and business. An evidence-based approach to collaboration—the science of collaboration—can be used to effectively evaluate partnerships, determine success, and improve present and future relationships.4 This article defines collaboration, how to achieve it, and how to overcome barriers to its implementation. WHAT IS COLLABORATION AND HOW IS IT ACHIEVED? The software company Kissflow defines collaboration as “the process of two or more people or organizations working together to complete a task or achieve a goal.”5 Often deemed vital for success, much of what we accomplish in our work or personal lives would not be possible without collaboration and communication. A cross-sectional study by Lavner et al. found that satisfied spouses tend to demonstrate more positive, less negative, and more effective communication.6 In addition to communication, other principles contribute to a team’s success or failure. Bosch and Mansell outlined five essential ingredients for effective collaboration and team success (Fig. 1).7 The first key ingredient for success is role clarity—each team member understands and is expected to execute his or her role. The second ingredient is trust and confidence—each member of the team must respect the training and education of his or her peers and know that every member has the betterment of the group as a priority. The third is the ability to overcome adversity; confidence enables teams to face problems with preparation and positive attitudes. The fourth is the ability to overcome personal differences. To accomplish this, every team member must put the team goal first, despite individual differences that may arise. The final ingredient is collective leadership, through which all team members contribute to setting goals and achieving them. Responsibilities are dispersed throughout the group, instead of being assigned to one individual. Taking these five ingredients into account at the outset and managing collaborations can help train teams to be goal-oriented and successful.Fig. 1.: Bosch and Mansell’s five essential ingredients for effective collaboration and team success.These ingredients for success can be realized through tangible policies and efforts within an organization. Harvard Business Review outlines eight ways to build collaborative teams (Fig. 2).8 First, successful organizations should invest in signature relationship practices. This may lead to variations in how organizations build teams, but they should remain distinctive to the company and help to further the mission of the team. For example, team leaders may use open floor plans to make their commitment to collaboration known throughout the company. In addition to physically encouraging collaborative efforts, leaders and executives should model collaboration among themselves to set an example. Organizations may also foster a “gift culture,” through which both informal and formal encouragement is used to help younger team members feel comfortable and integrate into the team. As collaborative efforts are modeled and encouraged, it is also necessary to ensure that employees have the requisite skills to know how to collaborate well. Skills such as engaging in purposeful conversations, conflict resolution, and program management can broaden a company’s collaborative culture from simply existing to being taught and practiced. Next, creating a sense of community within an organization can help increase comfort with other team members. Leaders should organize community events or support policies and practices that encourage this. To facilitate goal achievement and relationship building, teams should assign leaders who are both task and relationship oriented. Leaders should make goals clear and also mitigate tensions to information sharing. In addition to forming new relationships, teams should expand on previously established “heritage” relationships to hasten networking and communication between other team members. Finally, understanding role clarity and reducing task ambiguity is important to making collaboration as efficient as possible, thereby allowing individuals to use their specialized knowledge independently.8Fig. 2.: Eight ways to build collaborative teams.SPORTS AS A MODEL OF COLLABORATION From finance to food service, teams with unique goals are present in every field. Sports teams can serve as a model for team collaboration that can be applied to these various fields. In the initial states of collaboration, a sports team warming up before a game is similar to an organizational team holding meetings and events before diving into projects.9 Before expecting high levels of collaboration and goal achievement, relationships and familiarity among team members must be established. In the sports world, events such as team dinners, bus rides, and training drills can bond a group. In business and other fields, this can be achieved through in-person events and meetings, social networking tools, mentoring programs, and integration of disciplines. All of these measures ensure that newcomers are effectively integrated into the group, give more experienced members the opportunity to share their skills, and enable sharing of knowledge among group members.9 In addition to building relationships, a team’s members must play different roles and add different values to collaborate effectively. Not every player scores the goals on a successful team—there are both defensive and offensive players, and coaches, assistants, team captains, and more. Each member of the program must be clear in his or her role relative to the others on the team and focus on performing that role to the best of his or her ability. Teammates must also be receptive to overlapping roles and stepping outside of their assigned position to fulfill a need.7,10 For example, a physician may need to complete tasks that are normally performed by a nurse or resident. This can help achieve a goal despite unexpected challenges. Furthermore, it is not necessarily beneficial to have one “team captain.” Multiple team members may fill different leadership roles, enabling each to work to his or her strengths and equalize distribution of power.10 By distributing responsibilities, teams invite more voices and encourage communication throughout task completion. For example, an attending physician may be more responsible for formulating a care plan, whereas a resident may be more responsible for communicating with the patient. Finally, performance is directly related to team dynamics. A cohesive team with favorable power distribution achieves better outcomes than one where members perceive unfairness. By adopting strategies used by sports teams and effective organizations, individuals in the health care field can achieve a high level of functional communication, facilitate successful patient care, improve outcomes, and reduce errors. HOW DOES COLLABORATION APPLY TO HEALTH CARE? Collaboration in health care occurs when team members work together to create and implement patient care plans. Similar to sports and business, team members from different specialties bring their specialized knowledge to care effectively for the patient and educate peers. Measures to implement collaborative teams in health care lead to positive, tangible patient outcomes such as decreased lengths of stay, increased patient and family satisfaction, decreased morbidity and mortality rates, and reduced drug aversions.7,11 This collaboration can also extend beyond individual patient care to other aspects of health care and medicine. In research, collaborations may be necessary among different team members; disciplines; or even study centers, states, or countries. Isolated research efforts are limited by the workforce, expertise, and resources of the individual researcher. By introducing collaboration, these limitations can be lessened or removed, and better-quality research can be achieved, measured by increased citations and higher impacts.12,13 Communication and respect should be practiced to avoid conflicts related to language barriers, cultural norms, and role confusion. To understand which factors facilitate successful collaboration, we must also consider when collaborative efforts fail and the resulting consequences. Breakdown in collaboration and communication in health care leads to errors in practice, often resulting in patient injury or death. According to the Joint Commission, if medical errors were included in lists of top causes of death in the United States, they would rank number 5.11 Furthermore, Guttman et al. found that communication errors played a major role in 70% of adverse outcomes and 37% of extremely severe injury cases. Communication errors also result in significant monetary loss for health care systems, with U.S. hospitals losing approximately $2.2 million per year per health care system because of these errors.14 Communication errors were found to occur most commonly during shift changes and the transfer of patient care from one team to another.15 During these shift changes, health care workers can pass on ambiguous or incomplete information that can lead to mistakes and delays in care. When health care workers and institutions take measures to mitigate these errors, collaboration improves and, in turn, facilitates desired outcomes in both patient care and research impact. For example, implementing models to use at shift handovers and updating old communications systems are responsible for improving collaboration in hospitals.15 Making small changes to team communication has lasting and substantial results. HOW CAN EVIDENCE-BASED STRATEGIES BE USED TO IMPROVE COLLABORATIONS? In the realm of biomedical sciences, researchers have come to recognize how uncoordinated and inefficient partnerships prevent scientific innovations from occurring. The field of team science emerged with the focus of using multiple perspectives to analyze and subsequently create successful collaborations.16 Team scientists examine factors that can lead to coordinated participation in projects such as the presence of a reward, existing collaboration infrastructure, and the possibility of receiving an institutional award, such as a research grant. Hall et al. determined a few key attributes necessary for effective collaborations in science; these include a culture of appreciation and rewards for team effort, equitable research arrangements and collective leadership, and the engagement of higher-ups, among others.16 Without these attributes, collaborative efforts may fail or unravel. For example, Jonas Salk, a medical researcher whose laboratory developed the polio vaccine, announced the vaccine’s success during a press conference but failed to acknowledge the contributions of prior researchers or the members of his own laboratory that made the discovery possible. This led to frustration and, ultimately, the breakdown of the team as members left or found other work. This partnership, which had the opportunity to continue working together successfully, was surprisingly short-lived simply because of the failure of one team member to recognize the efforts of the others.17 Team science uses evidence-based techniques and strategies to determine the effectiveness of collaborations and improve them, both before and during their creation. One of the first measurable elements occurs before the actual partnership, by measuring a team’s readiness for collaboration. Rosas and Camarinha-Matos argue for including both “hard” (such as competency matching or technological preparedness) and “soft” (an organization’s character, willingness to collaborate, or empathetic relationships) aspects in any approach to assess collaboration preparedness.18 Using these factors, the researchers built a predictive model for collaboration preparedness based on a belief network. During the development of the actual partnership, factors based on different fields including social psychology, cyberinfrastructure, epidemiology, and more can be used to continually monitor and improve the partnership.19 For example, participatory goal setting and establishing communication patterns can encourage inclusiveness among members and provide team structure. This can be facilitated through experiential learning and appreciative inquiry. In addition, both intrapersonal and interpersonal factors can be honed to improve partnerships. Intrapersonally, this can be achieved by refining members’ individual attitudes toward collaboration, preparation for the complexities and tensions of collaboration, and leadership styles. Interpersonally, members’ familiarity, informality, social cohesiveness, diversity of perspectives and abilities, and communication styles should all be considered.20 Salk’s team, for example, may have benefitted from a discussion about when, where, and how team members should be credited for their work before any public recognition. Taking a moment to consider each individual’s perspective may have helped to identify and improve problem areas before an incident occurred. Once partnerships have been solidified and readiness assessed, evidence-based practices can continue to be used to evaluate and maintain the partnership. As the length of a partnership increases, new partners are added, others leave, and goals and values may become less clear. To mitigate this issue, performance management processes should be built into the collaboration. Periodic review checks can be used to see whether aims and objectives have changed, what is required to make any changes, and where attention should be focused. The Compassion Capital Fund provides a checklist for evaluation and monitoring21: Do partners share a common vision? Are partners willing to make changes to achieve shared goals? Does the group possess shared values and accepted principles? Does the group still meet the original need for its existence? Is there a clear understanding of own/other’s roles and responsibilities? Have these changed? How is this monitored? Is there adequate monitoring, evaluation, and feedback? These questions, and more, can be used to ensure the partnership continues to fulfill the role for which it was originally designed. WHAT ARE SOME COMMON BARRIERS TO COLLABORATION? When investigating how to improve collaboration efforts, researchers have identified common issues and barriers to collaboration. Explaining to Forbes why many collaborative efforts end up failing,22 collaboration expert and scientist Bob Johnson points to a group of scientists from multiple countries, including Mexico, Canada, the United States, and Germany, who were all working together under the guise of collaboration. In reality, each member was working toward different goals and had differing ideas. This collaboration failure led Johnson to reflect on communication strategies, and he realized a “blind spot”: in certain cases, these collaborative goals are underscored by biases and power hierarchies. Current successes and accolades may end up blocking a successful partnership. In addition, team members can fall victim to their own biases and defend their own ideas relentlessly, with no thought given to the knowledge and skills of other collaborators.11 When this occurs, the way someone communicates a message may create challenges. For example, one study on communication comparing spoken language to body language found that 93% of communication is more affected by tone, attitude, and body language, whereas only 7% of the purpose of the communication was derived from the actual words that were spoken. In fact, health care professionals often expect poor communication and ineffective collaboration, which furthers a self-fulfilling prophecy. Team members often ignore miscommunications and other issues, chalking them up to routine error, when these problems could instead be remedied through effective collaboration.11 Although some companies opt for alternative power structures, power hierarchies are common barriers to effective collaboration. Although some hierarchies can improve employee organization, strictly perceived or established hierarchies can lead to failures in communication and conflict between team members.11 Teams with lower concentration of power in specific individuals or groups show lower levels of conflict and have a more flexible hierarchical structure. Peers are often aware of each other’s relative levels of power and choose how they interact with someone on this basis.23 HOW CAN WE OVERCOME BARRIERS TO COLLABORATION; SPECIFICALLY, IN HEALTH CARE? With the acknowledgment of the existence of barriers to collaboration, the goal of overcoming them remains at the forefront, especially in high-risk health care settings. Weller et al. proposed a seven-step plan to overcome barriers to communication and collaboration in health care (Fig. 3)24:Fig. 3.: Seven steps to overcome barriers to communication and collaboration in health care. Teach effective communication strategies: Different tools can be used to ensure effective communication regardless of the situation. For example, closed-loop communication works by the sender directing instruction to the receiver; the receiver communicating what was said and how it was understood; and finally, the sender verifying that the message has been received and correctly interpreted. These strategies can be useful in situations such as patient handover, which is susceptible to errors resulting from miscommunication or lack of information. Train teams Teams who work together should train together to a better understanding of roles and improve patient Train teams using training provides for conflict and learning effective communication strategies that collaboration in of teams into a care plan a for open and new to problems This and the of to the health care team a trust can be established among team members when every and by should enable building trust and relationships with other team members. with and in high-risk such as the increase communication patient and can adverse outcomes to communication errors. an organizational culture that health care leaders must recognize the of collaboration and to help it within their organization. The that led to a need for increased collaboration and about many health care partnerships to and serve as of overcoming barriers to collaboration. development required the knowledge and communication of of scientists the further by and of required more than collaboration among but also between and science to share and ideas. Furthermore, these groups also with the to the helped the barriers between and in the face of a to a necessary collaborative strategies from health care, business, sports, and other fields can lead to a better more research, and patient from the of from and and a research from to study

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.